Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2015_PS-1503001 thru PS-1503500_ - PS-1503282

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AC"C� DATE(MMIDDIYYYY) 16.� CERTIFICATE OF LIABILITY INSURANCE 10/30/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Mar Nathan NAME: y Mid-Central Valley Insurance PHONE- (209)334-4242 I FAX (209)365 0684 (AIC,No,Ext)......._—_. ___.__...._ _.-_. _1 1E...NoJ 301 S. Ham Lane, Suite F E-MAIL ESS:mnathanCmcvins.com ADDR _ P.O. BOX 490 INSURER(S)AFFORDING COVERAGE NAIC# Lodi CA 95241 INSURERA Nautilus Insurance Company INSURED INSURER B: j Linden-Peters Chamber of Commerce _111 SURER P. 0. BOX 557 INSURER D -�.._^------- _INSURE=R Linden CA 95236 INSURER F: COVERAGES CERTIFICATE NUMBER:2015-2016 Liab Cert REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I T POLICY EFF POLICYEXP _. (NSR' - - "�ADDL.'SUBR� - LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYYI I(MMIDDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 _ _ _ DAMAGE TO RENTED I -- A CLAIMS-MADE _XJ OCCUR i100 If.PREMISES_(Ea occurrences. _$ 000 X I NN608694 11/1/2015 i 11/1/2016 MED EXP(Any one person) I$ 5,000 _._ PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ,000,000 -- X j POLICY i JERCOT- I LOC j PRODUCTS•COMP/OP AGG $ Included OTHER $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT (Ea accident) J$— ANY AUTO ( BODILY INJURY(Per person) $ - ALL OWNED I - SCHEDULED i - - -- _I AUTOS I 'AUTOS I BODI�NJURY(Peraccident) f-�-- NON-OWNED . HIRED AUTOS I PROPERTY DAMAGE I$ AUTOS (Per accident)_.. r - UMBRELLA LIAS I 5 OCCUR I EACH OCCURRENCE $ EXCESS LIAR RETENTIONS I � I AGGREGATE UED -- CLAIMS-MAD_E WORKERS COMPENSATION ! ! PER OTH- I AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIEfORPARTNERIEXECUTIVE Y LN i F OFFICERIMEMBER EXCLUDED'! J N l A ! EL EACH ACCIDENT i $ ((Mandatory in NH) 1 EL DISEASE-EA EMPLOYEE S I It yes.describe under T-- !DESCRIPTION OF OPERATIONS below j _ �I ! E.L.DISEASE-POLICY LIMIT I$ j I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Linden-Peters Chamber of Commerce Tree Lighting Ceremony 2015. San Joaquin County is additonal insured for Commercial General Liability per attached CG2011 01 96 endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE San Joaquin County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1810 E. Hazelton Ave, ACCORDANCE WITH THE POLICY PROVISIONS. Stockton, CA 95205 AUTHORIZED REPRESENTATIVE C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)